Cheney v. Standard Insurance

831 F.3d 445, 62 Employee Benefits Cas. (BNA) 1361, 2016 U.S. App. LEXIS 13692, 2016 WL 4011171
CourtCourt of Appeals for the Seventh Circuit
DecidedJuly 27, 2016
DocketNo. 15-1794
StatusPublished
Cited by22 cases

This text of 831 F.3d 445 (Cheney v. Standard Insurance) is published on Counsel Stack Legal Research, covering Court of Appeals for the Seventh Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Cheney v. Standard Insurance, 831 F.3d 445, 62 Employee Benefits Cas. (BNA) 1361, 2016 U.S. App. LEXIS 13692, 2016 WL 4011171 (7th Cir. 2016).

Opinion

WOOD, Chief Judge.

Carole Cheney was an attorney at Kirkland & Ellis, LLP (Kirkland) for approximately 20 years. She became a partner at the firm in 1997. She suffered from a spinal disease that first led her to seek accommodations in 1994, and ultimately resulted in a three-level anterior cervical discectomy and fusion and removal of her C5 vertebra in 2012.

Although Cheney had managed to work for many years despite her condition, by 2012 she had had enough, and so she submitted a claim for long-term disability benefits in July 2012. Standard Insurance Company (“Standard”)1, Kirkland’s insurer, denied her claim based on a finding that her coverage had ended in March of 2012, and that she was able at least through March to perform her job. (Although Standard’s initial denial used the March date, it never made that argument to the court and was thus not judicially estopped from arguing later, as it did, that coverage ended in December 2011.) After Standard refused to reconsider its position, Cheney sued in federal district court, raising claims under the Employee Retirement Income Security Act (ERISA), 29 U.S.C. § 1132. The parties consented to the jurisdiction of the magistrate judge, 28 U.S.C. § 636(c), and agreed to a trial based on the stipulated paper record. The court found in favor of Cheney, and Standard appeals. Because the district court made unsupported factual findings and misinterpreted the governing documents, we vacate its decision and remand for a new trial.

I

A

Cheney began working at Kirkland in 1991. In 1994, she requested ergonomic accommodations to mitigate neck .and lower back pain. Kirkland obliged. In 2003, she received permission to work mostly from home. She also began attending physical therapy and saw multiple orthopedic and chiropractic doctors. She was diagnosed in 2007 with degenerative disease of her cervical spine. For the first four months of 2010, Cheney’s pay was based on a 21-hour work week. In May of 2010, Kirkland sent her a letter confirming that she would be paid hourly, with no minimum required hours, until February 2011. But for the remainder of 2010, she did almost no legal work for the firm. Instead, from May to November 2010, Cheney campaigned for election as the DuPage County Board Chairman. Kirkland paid her nothing from May to October; in November, she worked seven hours; in December, she worked 17. In early 2011 Cheney returned to work at approximately 24 hours per week. But the political bug bit again, and so in September 2011 she announced her campaign for the Illinois House of Representatives. Her last hours were logged on December 19, 2011. She lost the primary on March 20, 2012.

In the meantime, Cheney’s condition was deteriorating gradually. Scans taken [448]*448in November and December 2011 showed degeneration and mild to moderate cervical and central spinal stenosis. Cheney’s physician, Dr. Staci Ahrens, reported that Cheney suffered a fall that exacerbated her pain in early October 2011. On October 25, Cheney indicated that she was feeling better. On November 15, Dr. Ahrens noted that Cheney “reports sitting and using the computer have been extremely bothersome .... She has experienced this issue for years, so she is extremely frustrated, as it does inhibit her ability to perform her job and disrupts her every ADL [activity of daily life] once exacerbated.” On November 18, Dr. Ahrens noted that Cheney had to discontinue doing paperwork because of her pain. On December 19, Dr. Ahrens reported that Cheney was “doing better and attempting to take frequent breaks” but that her neck pain was aggravated by carrying Christmas lights.

In November 2011, Cheney initiated a conversation with Kirkland about taking a six-month leave of absence. The firm approved a leave, which was to begin on January 3, 2012, and last until July of 2012. Her last day of work, however, was December 19, 2011. We will have more to say about the status of the two-week period between December 19 and January 3; it is enough for now to say that it is unclear.

On April 17, 2012, Cheney met with a neurosurgeon, who advised her to complete a twelve-week intensive physical therapy program and receive cervical epidural injection therapy. After the twelve-week program failed to improve Cheney’s condition, the neurosurgeon recommended cervical spinal fusion surgery, which Cheney received on August 27. Cheney submitted her claim for long-term disability benefits to Standard on July 17, just before the surgery.

B

The long-term disability policy Kirkland offered to its lawyers through Standard covers the “Member,” a term defined by the policy’s “Becoming Insured” and “General Policy Information” sections. Those sections describe “the Member” as a “regular employee” who is “Actively at Work at least 60% of the Employer’s full time schedule” or “A partner of the Employer who is Actively At Work for the Employer.” The policy defines “Active Work and Actively At Work” as “performing with reasonable continuity the Material Duties of your Own Occupation at your Employer’s usual place of business.” The policy also states that “Actively At Work [includes] regularly scheduled days off, holidays, or vacation days, so long as the person is capable of Active Work on those days.”

An employee must complete an “eligibility waiting period” before she is entitled to benefits. The policy states that an employee becomes eligible on the later of the Group Policy Effective Date — in this ease January 1, 2008 — or the date the employee becomes a Member. Once an employee is covered, if she “becomefs] disabled while insured under the Group Policy, [Standard] will pay [long-term disability] Benefits” after receiving satisfactory proof of loss.

The policy’s termination provision reads, in relevant part:

Your insurance ends automatically on the earliest of:
1. The date the last period ends for which a premium contribution was made for your insurance.
2. The date the Group Policy terminates.
3. The date your employment terminates.

[449]*4494. The day you cease to be a Member. However, your insurance will be continued during the following periods when you are absent from Active Work, unless it ends under any of the above.

a. During the first 90 days of a temporary or indefinite administrative or involuntary leave of absence or sick leave, provided your Employer is paying you at least the same Predisability Earnings paid to you immediately before you ceased to be>a Member....
b. ...
c. During any other temporary leave of absence approved by your Employer in advance and in writing and scheduled to last 9 months or less. A period of Disability is not a leave of absence.
d. During the Benefit Waiting Period.

Free access — add to your briefcase to read the full text and ask questions with AI

Related

Cite This Page — Counsel Stack

Bluebook (online)
831 F.3d 445, 62 Employee Benefits Cas. (BNA) 1361, 2016 U.S. App. LEXIS 13692, 2016 WL 4011171, Counsel Stack Legal Research, https://law.counselstack.com/opinion/cheney-v-standard-insurance-ca7-2016.